AN INTERVIEW with BARRY W. McCARTHY and MICHAEL E. METZ

Authors of
Coping with Erectile Dysfunction
and
Coping with Premature Ejaculation

Their new book Coping with Erectile Dysfunction has joined their earlier effort Coping with Premature Ejacualtion to create the most current and important series of books on males sexual problems to be released in the last ten years. We recently spent some time in conversation with sexual therapists Michael E. Metz and Barry W. McCarthy, asking them a few questions about erectile dysfunction and what, exactly, their new book proposes to do about it.

New Harbinger Publications: How do sexual-health professionals define erectile dysfunction (ED)?

Barry W. McCarthy: Sexual health professionals don’t agree on a definition of ED. If a man seldom gets an erection or avoids trying to have sex because of fear, clearly he is suffering from ED. ED can have physical, psychological, and relational causes. At the very least, ED involves a man who has lost his confidence in his ability to get and maintain an erection sufficient for intercourse and his uncomfortable with the situation. Our approach is to view the problem as a biopsychosocial issue, for which we favor a comprehensive approach to assessment and treatment.

NHP: How common in ED?

Michael E. Metz: The best research suggests that at any given point in time, approximately 12 percent of men suffer from significant ED, and there is an increasing amount of data demonstrating that, by age fifty, approximately one out of every two men complains about his erectile functioning and feels he has ED—at least in its mild form.

That is a very sobering statistic. Even more men feel low confidence and worry about performing well, which can cause intermittent ED and rob the man and his partner of pleasure and intimacy.

Our book is designed to honestly teach a man how to have “easy,” natural, and reliable erections, and how to cooperate with his partner for mutual pleasure.

NHP: What causes ED?

MEM: While the experience of ED is pretty much the same for all men—difficulty getting or keeping an erection sufficient for intercourse—there are actually ten different causes of ED. These fall within four general groups—physical, psychological, relational, and psychosexual skills.

The physical group of causes includes medical illnesses, physical injuries, personal lifestyle risks, drug side effects, and rare physiological system problems. The psychological group is comprised of psychological characteristics as well as individual psychological distresses. The relational group involves difficulties in relationship cohesion, cooperation, and emotional intimacy. In the psychosexual skills group, ED results from ineffective use of lovemaking skills.

Our book helps men and couples to understand the complexity of what can at first look like a fairly clear-cut and straightforward problem. You will need to look deeper than simply observing what is going wrong with your penis. Real-life problems are rarely simple, easy to solve, or magically dispelled, despite the man quick-fix promises that persist in popular culture.

NHP: Early in the book you address a number of myths about ED. Could you discuss a few of the more persistent?

BWM: Old sex myths die hard and are replaced by new sex myths. People used to believe that childhood issues caused all ED, and the only treatment was long-term psychotherapy. This has been replaced by the new myth that almost all Ed is caused by physiological problems, and no matter what caused the ED, medication alone would provide the man with a fail-safe erection.

A really persistent myth is that a “real” man can have sex with any woman, ant time, and in any situation. But the penis is not a performance machine! Male sexuality is influenced by a variety of physical, psychological, and relationship-based factors.

Perhaps the most harmful myth is that men ought to compare their sexual performance with what they see in movies or pornographic videos, with their easy, totally predictable, and powerful erections that don’t seem to need any stimulation from woman.

A new and very harmful myth is that the pro-erection drugs will return a man to the autonomous erections of his teens and twenties. In fact, Cialis, Viagra, and Levitra are helpful and safe medications, which increase erectile functioning. But they must still be integrated into the couple's sexual style of intimacy, pleasuring, and eroticism.

NHP: You mentioned the range of ED drugs. How do you feel about the advent of such medications as Viagra, Levitra, and Cialis? Is medication a valid treatment for ED?

BWM: ED is a biopsychosocial phenomenon—it is seldom totally physical or totally psychological.

The advent of Viagra in 1998 revolutionized the ED field and reduced the stigma surrounding ED. However, claiming that ED is basically a medical problem to be treated by medication only places all the pressure for overcoming the problem on the man, and this can create additional problems. A much more promising approach is to view ED as a couple’s issue and to integrate the medication into the couple's intimacy, pleasuring, and eroticism style.

For example, couples whose intimacy style tends to involve planning and structure often respond better to Viagra, which has a four-hour window of efficacy, while couples who prefer spontaneity might respond better to Cialis with its twenty-four to thirty-six hour effective period. We find that many couples use these medications to restore sexual self-confidence and then phase out the medication when there no longer needed.

NHP: What approach does your book use?

MEM: We believe that accurate and truthful knowledge is power. Every man deserves for his sexual life to be a positive force that illuminates all the other aspects of his life. This includes reestablishing confidence in his erections and his ability to have a rewarding sexual relationship. In this book, we offer the most up-to-date and helpful information about physiological, psychological, relational, and sexual-technique factors to help men learn to understand and to develop a personal approach to overcoming ED. This model encourages men to use all their recovery resources. Without a comprehensive approach, they are basically pursuing treatment that is only a partial effort almost certainly doomed to a disappointing result.

There are four phases of Skills Learning in our approach. The first phase involves a series of exercises to promote physical relaxation and comfort with sexuality. Readers learn cognitive and behavioral skills for relaxing their bodies, which sets the foundation for reliable erections. The second phase offers a series of exercises to lead men to experience easy, relaxed, dependable erections. By understanding how to get an erection, readers will build self-confidence by actually having erections? In the third phase, a series of techniques helps readers enjoy intercourse with new sexual confidence, pleasure, and closeness. We show how to build flexible intercourse scenarios and erotic playfulness. The fourth phase helps readers develop their own unique couple sexual style and to prevent relapse.

NHP: What are the benefits of viewing ED as a couple’s problem?

MEM: You need your partner’s help in addressing and changing ED. Think for a moment: sex is not just for you, nor is it just for her. Sex is for you as a couple. Your ED is also her ED! In addressing ED, your partner has an active role to play. She’s half of your intimate team, cooperating to regain comfort, confidence, and pleasure with your erections. Remember, sex is a team activity. We encourage you and your partner to enjoy intimacies in all sorts of ways that may (or may not) involve sexual intercourse.

Even if you do not currently have a partner, you do have a “virtual” partner where you recall past partner experiences or imagine a partner in the future. There is a benefit from reading and learning material about a new model of male sexuality, assessments and exercises you could do on your own, as well as ideas of how to approach ED issues with a partner in the future.

To work as an intimate team to develop a comfortable, functional couple sexual style will require changes not only for you, but your partner as well. She is used to your presenting with a spontaneous, autonomous erection. The wise and open woman accepts and embraces the opportunity to develop an intimate, interactive sexual relationship. She can enjoy taking an active role in helping build arousal. Arousal can be a synergistic process- each person’s sexual responsiveness invites and enhances your partner’s arousal. This is a more human, genuine sexual encounter.

NHP: What sort of long-term expectations can those who read your book and follow your program have?

BWM: Our hope is that the comprehensive couple program we describe will not only return the man to increased comfort and confidence with erections and intercourse but even more important enhance couple sexual pleasure and satisfaction. We advocate a new approach to male and couple sexuality which will ensure a satisfying sexual relationship as you and your partner age. Our relapse prevention program emphasizes positive, realistic sexual expectations with an emphasis on pleasure and satisfaction , not just intercourse performance.